Provider Demographics
NPI:1174860985
Name:OMATICK, MICHAELA MAY (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MAY
Last Name:OMATICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:MAY
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4128 STRAWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4264
Mailing Address - Country:US
Mailing Address - Phone:717-858-7414
Mailing Address - Fax:
Practice Address - Street 1:4128 STRAWBRIDGE CT
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4264
Practice Address - Country:US
Practice Address - Phone:717-858-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012698363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1616256OtherGATEWAY MEDICARE ASSURED
PA266685FLTMedicare PIN